Subacute osteomyelitis of the lower tibia (Brodie's Abscess)

Case contributed by A Prof. Essam G Ghonaim

Presentation

A young patient presented with an anterior lower left leg pain of several months duration, no past history of trauma or operations

Patient Data

Age: 22
Gender: Male

Radiographs showed an oval shaped lytic lesion of well defined outline seen involving meta-diaphyseal region of lower tibia being intra-medullary in location. It is seen surrounded by an irregular sclerosis. No cortical breaching and no periosteal reaction. The lesion is seen abutting corresponding lower tibial growth plate and not reaching lower tibial articular surface. 

 

An irregular yet well defined intra-medullary non-expanding lesion of abnormal signal intensity is seen involving the meta-diaphysis of the lower tibia. It has a small projection heading towards the growth plate (arrows).

The lesion shows classic penumbra sign. 

  

Case Discussion

Finger-like extension from the abscess directing towards the epiphyseal plate is said to be pathognomonic and indicates infection tunneling 1 and this communication with epiphysis is one of the what-does-the-clinician-want-to-know signs 2

 

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Case information

rID: 41166
Published: 3rd May 2018
Last edited: 5th May 2018
Inclusion in quiz mode: Included
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